Spasmodic Torticollis or Cervical Dystonia is a neurological condition thought to originate in the brain affecting certain muscles of the neck.

Dystonia is a generic name and means abnormal muscle tone. There are many different forms of dystonia, spasmodic torticollis or cervical dystonia is one of them.

Spasmodic Torticollis is thought to originate in the basal ganglia portion of the brain. A disturbance in the balance of chemicals produced in the brain may be responsible. One of these chemicals known as Acetylcholine may be affected. The neurotransmitters or chemical messengers secreted from the basal ganglia travel through nerve pathways to certain muscles of the neck. The increased nerve signals cause spasms to occur which cause the head to be pulled.

Cervical Dystonia causes the muscles of the neck contract uncontrollably, making the head turn into various postures. It can also be caused as the result of an accident. The spasms tend to worsen when a person stands or walks and can make simple tasks quite difficult.

The pain may become worse and, in many cases, severe. Symptoms will generally settle on one side of the neck; a shoulder may be higher; pain, numbness or tingling sensations may be felt in the arm or hand. At least two-thirds of the people who have cervical dystonia also experience neck pain that can radiate into the shoulders. The disorder also can cause severe headaches. In some people, the pain from cervical dystonia can be exhausting and disabling. If tremors are present, they will generally be in the head.

An accident, or a trauma of some kind, can trigger its onset. In approximately 50% of the spasmodic torticollis population, there is a family history of hand or head tremors.

The main neck muscles that are most prominently involved, are the sternocleidomastoid, trapezius, levator scapulae and splenius capitis. On occasion, when the muscles in the neck contract, they can cause tightness and contractions in the whole body.

Spasmodic torticollis is characterized by involuntary tonic contractions or intermittent spasms of neck muscles. Diagnosis is clinical and treatment can include physical therapy, drugs, and selective denervation of neck muscles with surgery or locally injected botulinum toxin.

Symptoms may begin at any age but usually begin between age 20 to 60, with a peak between age 30 to 50 and is more common in women. Symptoms usually begin gradually but may begin suddenly. Painful contractions or intermittent spasms of the sternocleidomastoid, trapezius, and other neck muscles occur, usually on one side, and result in abnormal head position. Sternocleidomastoid muscle contraction causes the head to rotate to the opposite side and the neck to bend to the same side. Besides rotational tilting (torticollis), the head can tilt laterally (laterocollis), forward (anterocollis), or backward (retrocollis). During sleep, muscle spasms disappear.

Spasmodic torticollis ranges from mild to severe. Usually, it progresses slowly for 1 to 5 yr, then plateaus. About 10 to 20% of patients recover spontaneously within 5 yr of onset (usually in milder cases with younger age onset). However, it may persist for life and can result in restricted movement and postural deformity.

While you might first discuss your symptoms with your family doctor, he or she may refer you to a neurologist - a doctor who specializes in disorders of the brain and nervous system for further evaluation.

Doctor appointments can be brief, so plan ahead and write a list that includes:

• Detailed descriptions of your symptoms, including when they started and if anything makes them better or worse
• Information about medical problems you've had in the past, such as strokes or head injuries
• Information about the medical problems of your parents or siblings
• All the medications and dietary supplements you take
• Any questions you may want to ask the doctor

In addition to conducting a physical exam, your doctor may also check your neurological health by testing your: Reflexes, Muscle strength, Muscle tone, Senses of touch and sight, Coordination and Balance. Your doctor may also ask you to rapidly open and close your fists several times, because this activity sometimes triggers the muscle contractions commonly seen in cervical dystonia

Your Doctor may also check for underlying conditions causing your signs and symptoms. These tests may include: Blood or urine tests to check for presence of toxins. Magnetic resonance imaging (MRI) to check for tumors or evidence of stroke. Electromyography (EMG) to measure the electrical activity of muscles which can help evaluate and diagnose muscle and nerve disorders and can help confirm whether you have cervical dystonia or another condition.

People who have spasmodic torticollis or cervical dystonia often use a combination of medications to reduce their signs and symptoms.

1) Botulinum toxin. This paralyzing agent, often used to smooth facial wrinkles, comes in two varieties - type A (Botox) and type B (Myobloc) - that can be injected directly into the neck muscles affected by cervical dystonia. Most people with spasmodic torticollis see an immediate improvement with this treatment, which usually must be repeated every three to four months.

2) Parkinson's drugs. Medications used to combat the tremors associated with Parkinson's disease, including trihexyphenidyl and benztropine, may be used in combination with botulinum toxin injections.

3) Muscle relaxants. These types of drugs also reduce anxiety, so they are especially helpful with symptoms that are worsened by stress. Examples include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin) and baclofen (Kemstro).

Stretching and strengthening exercises to improve posture can help reduce pain and may prolong the effect of botulinum toxin injections.

If less invasive treatments don't help, your doctor may suggest surgery.

Deep brain stimulation. This surgical procedure inserts a thin, insulated wire into the brain through a small hole cut into the skull. The tip of this electrode is placed in the portion of the brain that controls neck movement. The electrode is connected, via a wire that passes under the skin, to a small battery pack in your chest. The battery pack is about the size of a pocket watch, and it sends electrical pulses to the electrode to interrupt the nerve signals making your head twist.

Cutting muscles or nerves. Surgery to cut the nerves or muscles responsible for the contorted posture associated with cervical dystonia can be performed to help those who no longer get benefit from botulinum toxin or medications.

In addition to your regular treatment, techniques such as massage therapy, biofeedback and relaxation techniques may provide additional relief from your symptoms.

Other methods to try:

Reduce stress. Avoiding situations that cause stress or anxiety is important because stress tends to make your signs and symptoms worse.

Get your rest. Signs often disappear during sleep, so get plenty of rest. You may find relief by taking short breaks during your day to lie on your back and relax.

Try touching. Sensory tricks, such as touching the opposite side of your face or the back of your head, may cause spasms to stop temporarily. Different sensory tricks work for different people, and if you find one that works, it usually will continue to work for you.

Some neck supports may help provide relief. We have an adjustable Torticollis Collar in sizes from infants to adults.

Find support groups in your area or on the internet.